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Y2 - Resp > Lecture 19 - Pneumothorax And Pleural Effusion > Flashcards

Lecture 19 - Pneumothorax And Pleural Effusion Flashcards

1
Q

What is a pneumothorax?

A

Air in the chest that shouldn’t be there

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2
Q

What is the relative pressure in the pleural cavity?

A

Negative compared to atmosphere (essentially a vacuum)

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3
Q

What does a negative pressure mean

A

Pressure less then atmospheric pressure

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4
Q

What does a postive pressure mean?

A

Pressure greater than atmospheric pressure

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5
Q

Describe how the pressures change in the lung during inspiration and expiration:

A

Pressure in the lungs negative so air moves in until it becomes zero

Diaphragm relaxes making pressure in the lung negative forcing air out

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6
Q

What happens to the negative pressure in the pleural space with a pneumothorax?

A

Becomes closer to zero as air moves into it

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7
Q

How does air in the pleura affect the lung?

A

Reduces the pressure gradient and reduces the expansion of the lung

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8
Q

Why do you have pain on deep breathing with pneumothorax?

A

Can’t inflate lungs properly

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9
Q

What signs does a pneumothorax produce?

A

Reduced air on entry

Hyperresonant to percussion

Reduced chest expansion on affected side

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10
Q

What are the 4 types of pneumothorax?

A

Spontaneous (primary and secondary)
Iatrogenic
Simple
Tension

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11
Q

What is a spontaneous pneumothorax?

A

Pneumothorax occurring without obvious trauma iatrogenic cause

Primary
Secondary

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12
Q

What is considered a primary spontaneous pneumothorax?

A

No underlying lung disease

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13
Q

What is considered a secondary spontaneous pneumothorax?

A

With existing lung disease like COPD

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14
Q

What is an iatrogenic pneumothorax?

A

Caused by medical interventio n

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15
Q

What is a simple pneumothorax?

A

Where air iis going in and out so the volume of air in the pleura is not changing

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16
Q

What is a tension pneumothorax?

A

Air is going in but not coming out so the pneumothorax expands and gets bigger and bigger causing increased pressure on the mediastinal structures

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17
Q

What does SQITARS stand for?

A

Site
Quality
Intensity
Timing
Aggravating factors
Relieving factors
Symptoms (secondary)

Pain tool

18
Q

What does a pneumothorax look like of CXR?

Look at image 1 on last slide

A

Lung fields/markinggs dont extend to the lung margins

19
Q

What is the pneumonic used to remember how to study a CXR?

A

RIP ABCDE
Rotation
Inspiration
Penetration
Airway
Breathing
Cardiac
Dense structures
Everything else

20
Q

What would be found on exam with a pneumothorax?

A

Hyper resonant on percussion
Reduced air entry
Reduced vocal fremitus
Reduced chest expansion on affectd side

21
Q

How do you treat a pneumothorax?

A

Drain the air from the pleural space

Needle aspiration
Intercostal chest drain

22
Q

Where do you insert a chest drain to drain a pneumothorax?

A

Triangle of safety

23
Q

What are the borders of the triangle of saftey?

A

Pec major (lateral border)
Latissimus dorsi (lateral border)
5th intercostal space (mix axilalry line)

24
Q

When inserting a chest drain do you insert it above or below the rib?

A

Above to avoid intercostal neurovascular bundle

25
Q

How does the underwater seal work to drain a pneumothorax?

A

Allows air to be pushed out of the pleura but prevents air entering into the pleura

26
Q

How does a Tension Pneumothorax lead to death?

A

Increasing amount of air in pleural space compresses mediastinal structures (lungs and aorta leading to death)

27
Q

Look at last slide at CXR 2:

What it’s the diagnosis and why?

A

Tension pneumothorax

Trachea deviated to the right inducting mediastinal compression
At risk of cardiovascular collapse

28
Q

What leads to tachycardia and Tachypnoea in pneumothorax?

A

Compression of carotid sinus increases HR

Poor O2 sats leads to inc RR

29
Q

How do you treat a tension pneumothorax?

A

Quickly drain air
Chest drain in triangle of saftey

30
Q

What is pleural effusion?

A

Excess fluid in the pleural space

31
Q

What is a haemothorax?

A

Blood in the thorax

32
Q

What is a chylothorax?

A

Lymphatic fluid in the thorax

33
Q

What is an empyema?

A

Infection/pus in the pleura space

34
Q

What is a parapneumonic effusion?

A

Pleural effusion next to a pnemonia in the lung
Can be simple or complicated

35
Q

What are the 2 types of fluid a pleural effusion can be?

A

Transudate
Exudate

36
Q

What is transudate??

A

Fluid containing little protein

37
Q

What drives the formation of transudate?

A

High hydrostatic pressure (HF, liver failure, kidney failure)

38
Q

What is exudate?

A

Fluid high in protein

39
Q

What leads to the formation of exudate?

A

Changes in membrane permeability associated with inflammation

40
Q

What conditions lead to exudate being made?

A

Parappneumonic effusion
Malignancy

41
Q

How can you determine what’s exudate and what’s transudate?

A

Ratio of pleural fluid to serum protein is >0.5

Ratio of pleural fluid too serum LDH>0.6

Y2 - Resp (23 decks)

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